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This study examines the effects of different cigarette package warnings in Australia, Canada and the United Kingdom up to 5 years post-implementation. The data came from the International Tobacco Control Surveys. Measures included salience of warnings, cognitive responses, forgoing cigarettes and avoiding warnings. Although salience of the UK warnings was higher than the Australian and Canadian pictorial warnings, this did not lead to greater levels of cognitive reactions, forgoing or avoiding. There was no difference in ratings between the Australian and UK warnings for cognitive responses and forgoing, but the Canadian warnings were responded to more strongly. Avoidance of the Australian warnings was greater than to UK ones, but less than to the Canadian warnings. The impact of warnings declined over time in all three countries. Declines were comparable between Australia and the United Kingdom on all measures except avoiding, where Australia had a greater rate of decline; and for salience where the decline was slower in Canada. Having two rotating sets of warnings does not appear to reduce wear-out over a single set of warnings. Warning size may be more important than warning type in preventing wear-out, although both probably contribute interactively.

The aim of the present study was to assess smokers' level of agreement with smoking-related risks and toxic tobacco constituents relative to inclusion of these topics on health warning labels (HWLs). 1000 adult smokers were interviewed between 2012 and 2013 from online consumer panels of adult smokers from each of the three countries: Australia (AU), Canada (CA) and Mexico (MX). Generalized estimating equation models were estimated to compare agreement with smoking-related risks and toxic tobacco constituents. For disease outcomes described on HWLs across all three countries, there were few statistical differences in agreement with health outcomes (e.g. emphysema and heart attack). By contrast, increases in agreement where the HWLs were revised or introduced on HWLs for the first time (e.g. blindness in AU and CA, bladder cancer in CA). Similarly, samples from countries that have specific health content or toxic constituents on HWLs showed higher agreement for that particular disease or toxin than countries without (e.g. higher agreement for gangrene and blindness in AU, higher agreement for bladder cancer and all toxic constituents except nitrosamines and radioactive polonium in CA). Pictorial HWL content is associated with greater awareness of smoking-related risks and toxic tobacco constituents.

The objective of this study was to test the efficacy of specially designed educational materials to correct misperceptions held by smokers about nicotine, nicotine medications, low tar cigarettes, filters and product ingredients. To accomplish this, 682 New York State Smokers' Quitline callers were randomized to one of two groups: control group received counseling, nicotine patches and quit smoking guide; and experimental group received counseling, nicotine patches, quit guide, plus information about cigarette characteristics mailed in a brand-tailored box. Participants were contacted 1 month later to assess knowledge about cigarettes and actions taken to alter smoking behavior. The results found that respondents in the experimental condition were more likely to report using and sharing the test materials with others compared with the control condition. Overall mean knowledge scores for the experimental group were slightly higher compared with those who received the standard materials. Knowledge of cigarette ingredients was not related to quit attempts or quitting smoking. This study found that the experimental materials were better recalled and contributed to higher levels of knowledge about specific cigarette design features; however, this did not translate into changes in smoking behavior. (Contains 2 tables and 1 figure.)